Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
Authors: Chiara Robba, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Iole Brunetti, Janus C. Jakobsen, Gisela Lilja, Hans Friberg, Pedro D. Wendel-Garcia, Paul J. Young, Glenn Eastwood, Michelle S. Chew, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Martin Annborn, Miroslav Solar, Fabio S. Taccone, Josef Dankiewicz, Niklas Nielsen, Paolo Pelosi, Niklas Nielsen, Jan Bělohlávek, Clifton Callaway, Alain Cariou, Tobias Cronberg, Josef Dankiewicz, Glenn Eastwood, David Erlinge, Hans Friberg, Jan Hovdenes, Janus Christian Jakobsen, Michael Joannidis, Hans Kirkegaard, Helena Levin, Gisela Lilja, Matt P. G. Morgan, Alistair D. Nichol, Per Nordberg, Mauro Oddo, Paolo Pelosi, Christian Rylander, Manoj Saxena, Christian Storm, Fabio S. Taccone, Susann Ullén, Matt P. Wise, Paul J. Young, Kathy Rowan, David Harrison, Paul Mouncey, Manu Shankar-Hari, Duncan Young, Susann Ullén, Theis Lange, Karolina Palmér, Ulla-Britt Karlsson, Simon Heissler, Frances Bass, Naomi Hammond, John Myburgh, Colman Taylor, Adele Bellino, Marwa Abel-all, Ben Finfer, Carolyn Koch, Yang Li, Anne O’Connor, Julia Pilowsky, Tina Schneider, Anna Tippett, Bridget Ady, Tessa Broadley, Amanda Brown, Liz Melgaard, Mimi Morgan, Vanessa Singh, Rebecca Symons, Kathrin Becker, Nathalie Van Sante, Vendula Saleova, Silvie Zerzanova, Helena Levin, Samia Sefir-Kribel, Ute Lübeck, Mario Negri, Martina Carrara, Kathryn Fernando, Diane Mackle, Leanlove Navarra, Judith Riley, Elin Westerheim, Marianne Flatebø, Ameldina Ceric, Zana Haxhija, Lovisa Terling, Lena Bossmar, Liz Jergle, Helén Holm Månsson, Samia Abed Maillard, Andreja Vujicic Zagar, Christina Jodlauk, Helen Hill, Jennifer Scrivens, Kate Ainscough, Ciara Fahey, Rinaldo Bellomo, Leah Peck, Helen Young, Winston Cheung, Rosalba Cross, Michael Hayes, Nitin Jain, Mark Kol, Asim Shah, Atul Wagh, Helen Wong, F. Eduardo Martinez, Gail Brinkerhoff, Dustin Bush, Antony Stewart, Anders Aneman, Lien Lombardo, Peter McCanny, James Penketh, Ian Seppelt, Rebecca Gresham, Julie Lowrey, Kristy Masters, Christina Whitehead, James Walsham, Meg Harward, Josephine Mackay, Jason Meyer, Emma Saylor, Ellen Venz, Krista Wetzig, Wade Stedman, Angela Ashelford, Sharon Mar, Julia Pilowsky, Miyuki Tokumitsu, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Andrew Udy, Aidan Burrell, Jasmin Collins, Dashiell Gantner, Victoria Emma-Leah Martin, Phoebe Mccracken, Vinodh Nanjayya, Alistair Nichol, Alexander Sacha Richardson, Meredith Young, Angaj Ghosh, Simone Said, Michael Joannidis, Ronny Beer, Frank Hartig, Raimund Helbok, Sebastian Klein, Andreas Peer, Fabio S. Taccone, Jacques Creteur, Dominique Durand, Matthias Dupont, Sigrid Christiaens, Carola Claes, Sebastiaan Deckx, Bert Ferdinande, Sanne Lenaerts, Wilifred Mullens, Sarah Stroobants, Evi Theunissen, David Verhaert, Ondřej Šmíd, Marek Flaksa, David Kemlink, Jan Malík, Michal Otáhal, Jan Rulíšek, Michal Šíranec, Zdeněk Stach, Anna Valeriánová, Petra Zavadilova, Miroslav Solař, Róber Bánszky, Jana Červená, Renata Černá Pařízková, Libor Šimůnek, Filip Varhaník, Jiří Karásek, Matěj Strýček, Anders Grejs, Steffen Christensen, Peter Juhl-Olsen, Ida Katrine Thomsen, Lisa Gregersen Østergaard, Alain Cariou, Albert Cao, Pierre Dupland, Ariane Gavaud, Paul Jaubert, Mathieu Jozwiak, Nathalie Marin, Guillaume Savary, Nicolas Deye, Bruno Megarbane, Pierre Mora, Laetitia Sutterlin, Stephane Legriel, Hugo Bellut, Alexis Ferre, Guillaume Lacave, Marine Paul Jean-Baptiste Lascarrou, Emmanuel Canet, Charlotte Garret, Arnaud Felix Miaihle, Jean Reignier, Philippe Vignon, Thomas Daix, Arnaud Desachy, Bruno Evrard, Bruno Francois, Anne-Laure Fedou, Marine Goudelin, Christian Storm, Gabriele Kress, Christoph Leithner, Jens Nee, Kaspar Josche Streitberger, Iole Brunetti, Lorenzo Ball, Denise Battaglini, Giulia Bonatti, Iacopo Firpo, Paolo Frisoni, Arianna Iachi, Simona Maiani, Maura Mandelli, Chiara Robba, Fabio Tarantino, Alberto Barbieri, Elisabetta Bertellini, Enrico Giuliani, Gabriele Melegari, Erik Roman-Pognuz, Giorgio Berlot, Umberto Lucangelo, Elisabetta Macchini, Jan Hovdenes, Vibeke Aune, Tomas Drægni, Simon Jacobsen, Søren Pieschke, Åse Rasmussen, Gro Ringstad Akselsen, Halvor Langeland, Daniel Bergum, Therese M. Erbe, Pål Klepstad, Helle M. Næss, Roy Bjørkholt Olsen, Lena Eriksen Skjelnes, Marius Holen, Joakim Iver Post, Rune Fanebust, Linda Hårteig Sørensen, Ken Åge Kårstad, Carsten Fredrik Wickman, Paul Young, Colin Barnes, Ben Barry, Nina Beehre, Dick Dinsdale, Sam Edney, Anna Hunt, Harriet Judd, Charlotte Latimer-Bell, Cassie Lawrence, James Moore, Shaanti Olatunji, Alex Psirides, Chelsea Robinson, Kate Tietjens, Jason Wright, David Knight, Brandon Birker, David Bowie, Tara Burke, David Closey, Rosalind Crombie, Neil Davidson, Seton Henderson, Louise Hitchings, James McKay, Jan Mehrtens, Emmeline Minto, Stacey Morgan, Anna Morris, Jay Ritzemar-Carter, Jessica Roberts, Geoffrey Shaw, Katherine Townend, Kymbalee Vander Heyden, Christian Rylander, Marita Ahlqvist, Roman Desta Lindgren, Ingrid Eiving, Andreas Lundin, Patrik Martner, Elisabeth Myhrman, Birgitta Ryding, Joachim Düring, Mattias Bergström, Mattias Bohm, Ingrid Didriksson, Petrea Frid, Katarina Heimburg, Marina Larsson, Oscar Lundberg, Stefan Olsson Hau, Simon Schmidbauer, Ola Borgquist, Anne Adolfsson, Anna Bjärnroos, Erik Blennow-Nordström, Irina Dragancea, Thomas Kander, Anna Lybeck, Gustav Mattiasson, Olof Persson, Malin Rundgren, Susann Schrey, Erik Westhall, Martin Annborn, Sara Andertun, Florian Ebner, Nerida Gustavsson, Lisa Hassel, Jesper Johnsson, Marie Nelderup, Heléne Petersson, Jörgen Petersson, Frideriki Stafilidou, Johan Undén, Frida Antonsson, Git Bergman, Jörgen Gamroth, Maria Meirik, Katarina Rudolfsson, Helena Sandberg, Martin Thorsson, Kristin Savolainen, Maria Hansbo, Malin Helliksson, Björne Nödtveidt, Johan Sanner, Victoria Sem, Camilla Sund Lindquist, Akil Awad, Anna-Sofia Börjesson, Malin Hedberg, Mia Henning, Jacob Hollenberg, Per Petersen, Emelia Dahlberg, Johan Forshammar, Veronica Svensson, Michael Wanecek, Håkan Eskilsson, Daniel Rodriguez-Santos, Åsa Appelqvist, Henrietta Jidbratt, Elisabeth Johansson, Lars Kiszakiewicz, Åsa Nilsson, Sinnika Olsson, Anders Paulsson, Urszula Stempel, Andreas Thoren, Stefan Persson, Ida Berglund, Eric Bergström, Cathrine Törnqvist, Ingela Östman, Sten Rubertsson, Ing-Marie Larsson, Elin Söderman, Ewa Wallin, Joanna Wessbergh, Thomas Halliday, Filippa Engvall, Mauro Oddo, Nawfel Ben-Hamouda, Adriano Bernini, Pierre-Nicolas Carron, Philippe Eckert, Eva Favre, John-Paul Miroz, Paola Morelli, Olivier Muller, Jan Novi, Andrea Rosseti, Madeleine Schnorf, Matthias Haenggi, Anja Levis, Sandra Nansoz, Nicole Söll, Claudia Schrag, Mensur Alicajic, Philipp Baier, Joel Dütschler, Dominique Flügel, Edith Fässler, Ruth Gamio-Veis, Marc Güpfert, Yvonne Hilpertshauser, Stefan Hägele-Link, Gian-Reto Kleger, Peter Krähenmann, Maria Elisabeth Mair, Nadja Schai, Christoph Strohmaier, Peter Tangl, Dominik Zieglgänsberger, Marco Maggiorini, Gabriele Claus, Gabi Consani-Vogel, Lukas Imbach, Samira Kaiser, Eva-Maria Kleinert, Pedro David Wendel Garcia, Tiziano Cassina, Pamela Agazzi, Bruno Capelli, Gabriele Casso, Martino Regazzi, Hervé Schlotterbeck, Gabriele Via, Michele Villa, Matt P. Wise, Jenny Brooks, Eve Cocks, Jade Cole, Jacqueline Curtin, Michelle Davies, Rhys Davies, Stephen Fernandez, Julie Highfield, Helen Hill, Matt P. G. Morgan, Lydia Pennant, Sofia Rose, Emma Thomas, Angharad Williams, Peter McGuigan, Stephen Haffey, Aisling O’Neill, Kathryn Ward, Matthew Thomas, Jeremy Bewley, Anna Chillingworth, Julie Cloake, Libby Cole, Hilary Galvin, Zoe Garland, Lisa Grimmer, Bethany Gumbrill, Lucy Howie, Rebekah Johnson, Chloe Searles, Agnieszka Skorko, Katie Sweet, Victoria Taylor, Denise Webster, Thomas Keeble, Gill Adams, Rajesh K. Aggarwal, Jo-Anne Cartwright, Steven Church, Gerald J. Clesham, John R. Davies, Kelly Farrell, Reto Gamma, Jane Harding, Rohan Jagathesan, Alamgir Kabir, Paul A. Kelly, Lauren Kittridge, Maria Maccaroni, Gracie Maloney, Marco Mion, Naveen Nain, Raghunath Nalgirkar, Gyanesh Namjoshi, Stacey Pepper, Emily Redman, Nicholas M. Robinson, Jeremy Sayer, Amanda Solesbury, Kare H. Tang, Sali Urovi, Kunal Waghmare, Noel Watson, Teresa Webber, Peter Isherwood, Conor Bentley, Colin Bergin, Ronald Carrera, Amy Clark, Lauren Cooper, Liesl Despy, Natalie Dooley, Karen Ellis, Emma Fellows, Stephanie Goundry, Samantha Harkett, Christopher McGhee, Aoife Neal, Hazel Smith, Catherine Snelson, Elaine Spruce, Tony Whitehouse, Kamal Yakoub, Andrew Walden, Shauna Bartley, Parminder Bhuie, Matthew Frise, Nicola Jacques, Liza Keating, David Pogson, Zoe Daly, Steve Rose, Jonathan Bannard-Smith, Rachael Quayle, Nigel Chee, Nina Barratt, Katie Bowman, Debbie Branney, Elizabeth Howe, Maria Letts, Sally Pitts, Luke Vamplew, Clifton W. Callaway, Sara Difiore Sprouse, Ankur A. Doshi, Jennifer Fugate, Amy M. Headlee, Eelco F. M. Wijdicks
Journal: Intensive Care Medicine (2022)

The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.